<!DOCTYPE html>
<html>
	<% include ../../includes/header %>
</head>
<body class="skin-blue">
	<% include ../../includes/navbar %>

            <!-- Right side column. Contains the navbar and content of the page -->
            <aside class="right-side">
                <!-- Content Header (Page header) -->
                <section class="content-header">
                    <h1>
                        PROCESS PAYMENT
                        <small>User - Form</small>
                    </h1>
                    <ol class="breadcrumb">
                        <li><a href="/admin"><i class="fa fa-dashboard"></i> Home</a></li>
                        <li class="active">User Form</li>
                    </ol>
                </section>
				
                <!-- Main content -->
                <section class="content">
					<div class="col-lg-7 col-lg-offset-3 text-center">
						<div class="row ">
	                        <!-- left column -->
	                        <div class="col-md-11 ">
	                            <!-- general form elements -->
	                            <div class="box box-primary">
	                                <div class="box-header" >
	                                    <h3 class="box-title">User</h3>
	                                </div><!-- /.box-header -->
	                                <!-- form start -->
	                                
	                                <form action='<%- id %>' method='post'>
	                                
	                                    <div class="box-body">
	                                    
	                                        <div class="input-group">
		                                        <span class="input-group-addon" ><b>Username</b></span>
	                                            <input name="username" type="text" class="form-control" value="<%- record['username'] %>" placeholder="Enter username">
	                                        </div><br/>
	                                        
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Password</b></span>
	                                            <input name="password" type="text" class="form-control" value="<%- record['password'] %>" placeholder="Enter password">
	                                        </div><br/>
	                                        
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Confirm Password</b></span>
	                                            <input name="confirm_password" type="text" class="form-control" placeholder="Enter confirm password">
	                                        </div><br/>
	                                        
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Email</b></span>
	                                            <input name="email" type="text" class="form-control" value="<%- record['email'] %>" placeholder="Enter email">
	                                        </div><br/>
	                                        
	                                       <div class="input-group">
		                                        <span class="input-group-addon"><b>First Name</b></span>
	                                            <input name="first_name" type="text" class="form-control" value="<%- record['firstname'] %>" placeholder="Enter first name">
	                                        </div><br/>
	                                        
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Middle Name</b></span>
	                                            <input name="middle_name" type="text" class="form-control" value="<%- record['middlename'] %>" placeholder="Enter middle name">
	                                        </div><br/>
	                                        
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Last Name</b></span>
	                                            <input name="last_name" type="text" class="form-control" value="<%- record['lastname'] %>" placeholder="Enter last name">
	                                        </div><br/>
	                         
	                                        <div class="input-group">
		                                        <span class="input-group-addon"><b>Status</b></span>
		                                        <select name="status" class="form-control">
		                                        	<option><%- record['status'] %></option>
		                                        	<option>Positive</option>
		                                        	<option>Negative</option>
		                                        </select>
		                                    </div>
	                                      
	                                    </div><!-- /.box-body -->
	
	                                    <div class="box-footer">
	                                        <input type="submit" class="btn btn-primary btn-lg " value="Save" />
	                                    </div>
	                                </form>
	                            </div><!-- /.box -->
							</div>
						</div>
					</div>
					
                </section><!-- /.content -->
            </aside><!-- /.right-side -->
        </div><!-- ./wrapper -->

		<% include ../../includes/footer %>

    </body>
</html>